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DISCLAIMER
This is a personal web site, reflecting the opinions of its author. It is not a production of my employer, and it is unaffiliated with ANY hospital, medical center, medical practice or other physicians. Statements on this site do not represent the views or policies of anyone other than myself. The information on this site is provided for discussion purposes only, and are not medical recommendations. I offer no guarentee as to the accuracy of anything stated and the information here is at times, highly speculative and does not constitute advice to/not to diagnose or treat. Any personal medical issues the reader may have should be referred immediately to the reader's private physician and under no circumstances should anyone delay, change, or alter any medical treatment or planned treatment or diagnosis based on anything read on this site. Under no circumstances does any herein contained information represent a medical recommendation.

EMERGENCY

If you have worked in a hospital, as I have, over the past 15-20 years, you have noticed a striking increase in emergency room visits.

And we aren't talking about people with crushed bones and severed limbs. No. If your emergency room is anything like mine, it is filled to bursting, 24 hours a day with patients complaining of runny noses, stomach cramps, headaches, bruises, nearsightedness...the quotidian medical affairs that at one time were attended to by the family doctor.

If you walk through the waiting room, where patients sit for 5 and 6 hours to see a doctor for these mundane ailments, you'll see a population predominently composed of the young, the poor, immigrants, illegal aliens, migrant workers, and a smattering of the middle class.

Although this population is disparate, it has a common bond drawing it to the ER at all hours, for any physical complaint: no health care insurance.

The Emergency Medical Treatment and Labor Act of 1986 (EMTLA) prohibits hospitals from turning away patients who arrive with a complaint. Originally intended to prevent patient "dumping" (where a private hospital buys a taxi ride to a public hospital for an uninsured patient), the omnipresence of liability lawyers has forced expansion of the Act's intent to cover everyone (including noncitizens and illegal aliens) who walks through the door, no matter what the complaint.

Because people know a good thing when they see it, smart consumers who are pinched for cash drop their health insurance because now they are covered. Covered for cuts and scrapes, for pregnancy, for cancer -- you name it. It can be a $15.00 problem or a million dollar problem.

In addition, foreigners, illegal aliens and migrant workers pass the word around their community and in their home countries: free care in the U.S. at the hospitals. All you have to do is wait in the ER! I have seen many patients who fly to Florida from the Carribean and walk into the ER to get an obstetrical ultrasound, or be casted, or just for a check-up. A flight from the Dominican Republic is cheap compared to an MRI of the brain to follow-up a lesion.

So when politicians claim that there is a HEALTH CARE CRISIS, and then adduce the growing number of uninsured as proof of this crisis -- toss it right back at 'em. Ask them to show you a graph showing the percentage of uninsured per year before 1986, and after 1986. Ask them about EMTLA.

The cost of all this free care? $22 billion last year, and going nowhere but up.

My personal experience with the EMTLA is that a hospital can do triage screening and then bill for the entire emergency room visit, icluding doctors fees. All this without any physical exam or treatment of any kind. This happend to me when I arrived with dry-socket which is a dental problem. The hospital in question informed me after triage that it does not treat dental problems. I am in a billing dispute over $138.00 for emergency services in the emergency room (cost of triage?) and doctors bills in the amount of $164.00. This occurred in Brevard County in Central Florida. So that now we see that the hospital followed the letter of the law but not the intent of the law. They do not provide dental services and did not tell me this until a physicians assistant took me to an exam room. No exam was performed. Worse yet when I filed a complaint with AHCA the staff involved (1 PA and 1 Dr.) lied and said that they did preform an exam. Pretty scary when the medical establishment starts lying over billing disputes. It makes me wonder what they would do with a malpractice suit. I also wonder how many other hospitals are taking advantage of the EMTLA and billing for treatment not received. Talk about fraud! And it is legal fraud! This loophole needs to be closed. I acknowledge that people try to take advantage of a system, it has always been so. But how about the system taking advantage of people? That's legal so it is justified. This is a white collar crime, make no mistake about it. A reasonable fee for triage would be in order. Full billing for services not received is a deceptive and fraudulent practice!